A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model.

In this study, we tested the null hypothesis that intraperitoneal adhesion formation and reduction after laser surgery are the same whether the surgery is performed by laparoscopy or laparotomy. Twenty rabbits were randomly assigned to either laparoscopy or laparotomy and subjected to standardized laser incisions over one uterine horn and over the peritoneal surface of either lower quadrant. Three weeks later, five animals from each group underwent laparoscopy and the other five received laparotomy to score the extent of postoperative adhesions formed and to carry out laser adhesiolysis. The same power density was delivered to tissues in both procedures. Three weeks after the second operative intervention, the animals were killed and the intraperitoneal adhesions blindly scored (scale of 0-3). After the initial procedure, adhesions were absent in the laparoscopy group, but in the laparotomy group, adhesions were frequently present not only at the operative sites of the peritoneal surfaces and uterine horn, but also on the bowel, bladder, and opposite uterine horn where no apparent injury had been inflicted (P less than .005). Three weeks after adhesiolysis, a significant reduction was observed in the mean adhesion scores in the laparoscopy group, but not in the laparotomy group (P = .001). These results lead to the rejection of the null hypothesis and confirm the clinical observation that besides reducing operative trauma, discomfort, and cost, laparoscopic laser surgery is very effective in reducing intraperitoneal adhesions and causes significantly less postoperative adhesion formation than does laparotomy.

Morbidity from in vitro fertilization secondary to instrument failure: a case report.

This case illustrates the need for careful monitoring of equipment used for assisted reproduction. Unfortunately, most such devices have been considered investigational and have not been held to the usual scrutiny of government regulating agencies.

Computer-assisted assessment of hamster ovarian follicle pools: a novel approach.

With computerized image capture, primordial and primary follicles were easily and reproducibly measured. This technology appears ideal for following rarely studied small follicle populations and may have utility in the direct evaluation of superovulation protocols and other drug therapy.

Flow cytometric analysis of induced human graafian follicles. I. Demonstration and sorting of two luteinized cell populations.

STUDY OBJECTIVE: To test the hypothesis that induced human graafian follicles consist of different steroidogenic cell types on the basis of their light scatter characteristics as determined by flow cytometry. DESIGN: Cross-sectional, observational study. SETTING: Flow cytometry laboratory. PATIENTS: Thirty-six follicular aspirates from nine consecutive patients undergoing in vitro fertilization for tubal factor infertility were evaluated. RESULTS: Two distinct luteal cell populations were recovered. Both populations were positive by Oil Red O staining, suggesting the presence of intracellular lipid. Neither population stained positively for the presence of HLe-1/CD45, an antigen present on all human leukocytes. CONCLUSIONS: Cellular heterogeneity exists within the granulosa cell compartment.

Leuprolide acetate treatment of catamenial pneumothorax.

A 35-year-old nulligravid female with a 20 pack year history of smoking and continuous OC use since age 16 presented with recurrent pneumothoraces coinciding with the onset of menses at age 28. At that time she underwent a right partial pleurectomy and lobectomy, which demonstrated bullous disease but no glandular or stromal elements. Although catamenial respiratory discomfort persisted while on OCs, no pneumothoraces were documented until age 33 at which time she was given the diagnosis of catamenial pneumothorax. A diagnostic laparoscopy failed to demonstrate endometriosis or the presence of diaphragmatic defects. In an effort to preserve her fertility, she began a course of LA-GnRH-a therapy with depot LA. Because of disabling vasomotor and emotional side effects, continuous conjugated estrogens and MPA acetate were given as add-back therapy. She has remained symptom and side effect free for over 2 years on this regimen.

Human chorionic gonadotropin localization and morphometric characterization of human granulosa-luteal cells obtained during in vitro fertilization cycles.

The area and cytoplasmic-to-nuclear ratio (C/N) of cells aspirated from follicles with mature oocytes was determined using a computerized image analysis system. The presence of human chorionic gonadotropin (hCG) on the surface membrane and/or within the cytoplasm of each cell also was determined using a horseradish peroxidase immunocytochemical procedure. Based on morphometric characteristics, follicular cells were classified as granulosa or luteal. Granulosa cells were less than 75 micron 2 in area with a C/N of approximately 0.5. Luteal cells were classified as small (less than 75 micron 2, C/N approximately 1.5), midluteal (76 to 100 micron 2, C/N greater than 1.5) and large luteal (greater than 100 micron 2, C/N greater than 1.5). Compared with aspirates from follicles containing fertilizable oocytes, aspirates from follicles with nonfertilizable oocytes had fewer granulosa cells and more large luteal cells. HCG was localized on the membranes of granulosa and small luteal cells and within the cytoplasm of midluteal cells. Human chorionic gonadotropin was generally not observed on either the membranes or cytoplasm of luteal cells over 120 micron 2. These data support the concept that granulosa cells bind hCG to membrane receptors, internalize hCG, and begin to luteinize in response to hCG stimulation. Since the aspirates from follicles containing nonfertilizable oocytes possessed a higher percentage of large luteal cells, it is postulated that the cells from these aspirates began the luteinization process earlier than those from follicles containing fertilizable oocytes.

Cellular localization of müllerian inhibiting substance messenger ribonucleic acid during human ovarian follicular development.

Müllerian inhibiting substance is expressed in the human reproductive system and has been associated with oocyte meiotic arrest. In situ hybridization was used to selectively localize ovarian cells containing high levels of müllerian inhibiting substance messenger ribonucleic acid, a müllerian inhibiting substance precursor, during different stages of human follicular development. Müllerian inhibiting substance transcript was noted in the granulosa cells of primordial, primary, and antral follicles. Surprisingly, transcript was also identified within the cytoplasm of oocytes and throughout the ovarian stroma. Controls included sense oligoprobe, positive and negative tissue controls, and treatments minus the detection antibody. Localization of transcript within the cytoplasm demonstrates that active transcription of müllerian inhibiting substance messenger ribonucleic acid occurs within both fetal and adult human female gonads. The presence of müllerian inhibiting substance messenger ribonucleic acid within oocyte cytoplasm could implicate an autocrine role for müllerian inhibiting substance-derived peptides in the establishment of oocyte competence.

Kininogen present in rat reproductive tissues is apparently synthesized by the liver, not by the reproductive system.

OBJECTIVE: The purpose of this study was to determine the source(s) of the reproductive tract kininogen and to assess whether kininogen transcription is influenced by reproductive conditions. STUDY DESIGN: Rats in various reproductive states (immature, mature, ovulatory, luteal phase, pregnancy, parturition, postpartum) were used to obtain reproductive tissues (follicles, corpora lutea, oviduct, uterus, testes) and liver. Complementary deoxyribonucleic acid probes for rat prekininogens were used to quantify kininogen messenger ribonucleic acid synthesis. RESULTS: The T-prekininogen complementary deoxyribonucleic acid probe detected a single 1.6 kb message, whereas the k-prekininogen complementary deoxyribonucleic acid probe identified two messages, an abundantly expressed 1.6 kb band and a 2.2 kb band. The source of all the three prekininogen messages appears to be the liver. Naturally occurring reproductive conditions such as ovulation, implantation, and parturition, did not turn on prekininogen message transcription in the rat gonad or genital tract. Only decidualization of the uterus was associated with the induction of kininogen transcription in the liver. CONCLUSION: There appears to be little, if any, contribution of local gene expression to the kininogen present in the reproductive tissues. Apparently, the reproductive tract increases uptake of kininogen from plasma as needed.

Differential induction of c-jun expression by PGF2-alpha in rat ovary, uterus and adrenal.

The influence of PGF2 alpha on c-jun gene expression in ovary, uterus and adrenal was examined. Three and seven day postovulatory PMSG primed immature rats received 500 ug PGF2 alpha by two subcutaneous injections 8 hours apart. Control rats received saline. Animals were sacrificed 30 minutes after the second injection of PGF2 alpha. Tissues were obtained and frozen in liquid nitrogen. RNA extracted from ovary, uterus and adrenal was analyzed by Northern and slot blot. c-jun was expressed differentially in these organs. An increase in c-jun expression by PGF2 alpha treatment occurred in the ovary but not in the adrenal and uterus. The effect of PGF2 alpha on c-jun was stronger in older compared to younger corpora lutea. These results indicate differential regulation of c-jun by PGF2 alpha in steroidogenic and steroid responsive tissues and that c-jun might be linked to the mode of action of PGF2 alpha in luteolysis.

Etiologic factors of recurrent abortion and subsequent reproductive performance of couples: have we made any progress in the past 10 years?

OBJECTIVES: We hypothesize that the diagnostic yield and pregnancy outcomes of patients with recurrent abortion have improved over the past 10 years. STUDY DESIGN: The study was performed in an academic medical center. Diagnoses and outcomes for group A, a published series of 100 patients investigated for recurrent abortion in the section between 1968 and 1977, was compared with those for group B, the 131 patients seen between 1987 and 1991. A standardized protocol was followed, enhanced by new techniques and autoimmune investigations in the latter group. Results were compiled retrospectively. Descriptive statistics and chi 2 analysis were used. RESULTS: No cause could be found in 37% of patients in group A compared with 24% of couples in group B (p less than 0.05). No clear difference could be shown in the subsequent outcomes of pregnancies. CONCLUSIONS: Our ability to establish a cause of recurrent abortion has improved slightly over the past 15 years. The gain is not yet reflected in successful pregnancy rates. Multicenter trials are indicated.